It has been recently recognized that poor oral hygiene may contribute to various systemic diseases. Oral bacteria are normally present in the mouth, and include strains of streptococci, lactobacilli, staphylococci, corynebacteria, and various anaerobes, particularly bacteroides. Although such bacteria can be beneficial to one's health, some bacteria can be harmful and cause serious illnesses; for example, Streptococcus mutans converts sugars and starches into acids and enzymes which dissolve tooth enamel, and causes pneumonia, sinusitis and meningitis.
Bacteria, acid, food debris, and saliva combine in the mouth to form a sticky substance known as plaque which adheres to tooth, tongue and gum surfaces within twenty minutes after eating. Plaque accumulation causes inflammation of the gums or gingivitis, and can progress to destruction of the ligaments and bone that support the teeth (i.e., periodontitis). Plaque which is not removed from the teeth mineralizes into calculus which can cause halitosis, receding gums, and chronically inflamed gingiva.
Further, the bacteria in plaque and calculus can disseminate from the mouth into other areas of the body such as the bloodstream and lungs. Three pathways linking oral infections to systemic effects have been proposed (Li et al., 2000). Bacteria may enter the bloodstream and circulate throughout the body to settle at a particular site, may produce exotoxins which are harmful to the body, and/or may form immunocomplexes which may promote inflammatory reactions. Systemic diseases associated with oral infection include cardiovascular diseases, coronary heart disease, infective endocarditis, bacterial pneumonia, lung disease, osteoporosis, diabetes mellitus, and low birth weight (De Oliveira et al., 2010; Deshpande et al., 2010; Kelsey et al., 2008; Lockhart et al., 2009; Michalowicz et al., 2006; Raghavendran et al., 2007; Spahr et al., 2006).
Prevention of plaque and calculus may be achieved by regular professional cleaning and diligence in brushing and flossing. However, many people do not make a regular practice of visiting their dentists or caring for their teeth. Many dentists recommend professional cleaning every six months. However, peridontal scalers or ultrasonic tools for removing deposits from teeth often cause discomfort, such that patients generally defer or avoid their appointments. Further, patients who have lower incomes (e.g., seniors) or lack dental insurance have less access to oral care services.
Dental professionals recommend brushing twice a day or after meals, and flossing daily. However, most people do not have the inclination or time. Those with sensitive teeth or irritated gums may avoid proper care of the affected areas. Certain pharmaceutical drugs (e.g., phenytoin, cyclosporine, calcium channel blockers such as nifedipine and amlodipine) cause gingival hyperplasia, which facilitates invasion of bacteria into the gums to cause painful irritation or inflammation (Lowenthal et al., 2001). As a result, those afflicted are less likely to brush, making gingivitis more likely to develop or worsen.
Various articles have been developed to facilitate care for the teeth and gums, including bristled manual or electric toothbrushes, dental floss, and interdental cleaners. Manual toothbrushes require effort, skill and brushing force which can damage teeth if overly vigorous. In contrast, electric toothbrushes require minimal skill, are effective for people with arthritis or other physical limitations, and are ergonomic for a comfortable grasp. However, electric toothbrushes are bulky, more expensive than manual toothbrushes, difficult to maneuver, require battery replacement or recharging, necessitate the purchase of replacement heads every three to four months, and generally do not provide soft or extra-soft bristles for very sensitive teeth.
After multiple uses, bacteria tend to accumulate in toothbrush bristles which are difficult to disinfect thoroughly without the use of antimicrobial solutions or decontamination techniques which tend to be unavailable to consumers (Komiyama et al., 2010; Sato et al., 2004). The ability of brushes to remove plaque has been found to be significantly reduced after as little as ten weeks (Rawls et al., 1989). Since splaying of bristles increases with use, cleaning efficiency subsequently decreases.
Dental floss removes unwanted debris which collects between the teeth and which is not always removed by a toothbrush. If used improperly, dental floss can scrape the insides of the teeth, rupture gum tissue, and cause unnecessary bleeding. There may be areas where dental floss becomes stuck due to tightly spaced teeth, or frays due to rough or sharp areas found on either the surface of a tooth or a dental restoration such as a filling, crown or veneer. Alternatively, a flossing handle, electric or pre-threaded flosser, or interdental cleaner such as a dental pick or stick may be used to clean between teeth. However, all flossing methods require dexterity and patience. A water pick or oral irrigator aims a stream of water at the teeth and may help to remove large particles, but is not generally considered a substitute for brushing and flossing.
A problem shared by the above cleaning articles is that they are cumbersome, bulky or inconvenient to carry such that many forego carrying a toothbrush and/or floss with them, leading to poor oral hygiene. There is often a lack of opportunity to brush or floss during work or social activities, or facilities available to brush or floss in privacy.
Accordingly, there is thus a need in the art for improved articles and methods for caring for the teeth and gums.